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Weil?s syndrome
Weil's syndrome, is caused by water borne infection by Leptospira icterohemorrhagica
and is the most severe form of leptospirosis.
Clinical manifestations
The incubation period is approximately 2 weeks.
The onset of illness is no different from that of less severe leptospirosis
with Leptospirosis may present as an acute influenza-like illness, with
fever, chills, severe headache, nausea, vomiting, and myalgias. Muscle
pain, which especially affects the calves, back, and abdomen, is an important
feature of leptospiral infection. However, unlike milder leptospirosis
after 9 days, jaundice as well as renal and vascular dysfunction generally
develop. Although some degree of defervescence may be noted after the
first week of illness, a biphasic disease pattern like that seen in anicteric
leptospirosis is lacking. The jaundice of Weil's syndrome, which can be
profound and give an orange cast to the skin, is usually not associated
with severe hepatic necrosis. Death is rarely due to liver failure. Hepatomegaly
and tenderness in the right upper quadrant are usually detected. Splenomegaly
is found in 20% of cases.
Renal failure may develop, often during the second week of illness. Hypovolemia
and decreased renal perfusion contribute to the development of acute tubular
necrosis with oliguria or anuria. Dialysis is sometimes required, although
a fair number of cases can be managed without dialysis. Renal function
may be completely regained.
Pulmonary involvement occurs frequently, resulting in
cough, dyspnea,
chest pain, and blood-stained sputum, and sometimes in hemoptysis or even
respiratory failure. Hemorrhagic manifestations are seen in Weil's syndrome:
epistaxis, petechiae, purpura, and ecchymoses are found commonly, while
severe gastrointestinal bleeding and adrenal or subarachnoid hemorrhage
are detected rarely.
Rhabdomyolysis, hemolysis, myocarditis, pericarditis, congestive heart
failure, cardiogenic shock, adult respiratory distress syndrome, and multiorgan
failure have all been described during severe leptospirosis.
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Diagnosis
A definite diagnosis of leptospirosis is based either on isolation
of the organism from the patient or on seroconversion or a rise in antibody
titer in the microscopic agglutination test (MAT).
Treatment
Antimicrobial therapy should be started at once. Intravenous
administration of penicillin G, amoxicillin, ampicillin, or erythromycin
is recommended.
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